The rule, issued today, becomes effective in 30 days. Its main provisions widen the number of health workers and institutions that may refuse, based on "sincere religious belief or moral conviction," to provide care or referrals to patients.

"This rule protects the right of medical providers to care for their patients in accord with their conscience," says Health and Human Services Secretary Michael O. Leavitt in a statement.

Previous rules allow health care workers to refuse to provide abortion or sterilization services to which they are morally opposed. The new rulings give individuals and institutions much greater leeway in refusing to provide services to which they are morally opposed.

The ruling, issued by the Department of Health and Human Services, covers an estimated 571,947 "entities" including doctors' offices, pharmacies, hospitals, insurers, medical and nursing schools, diagnostic labs, nursing homes, and state governments.

Each of these entities is required to certify in writing that they will comply with the ruling. Failure to comply may be punished with loss of federal funding.

A wide number of medical groups strongly oppose the new ruling. These groups include the American Medical Association (AMA), the American Nurses Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and 27 state medical associations.

The focus of the new ruling is on protecting health care workers and institutions that oppose abortion and a broad interpretation of "sterilization."

"Today's regulation issued by HHS under the guise of 'protecting' the conscience of health care providers, is yet another reminder of the outgoing administration's implicit contempt for women's right to accurate and complete reproductive health information and legal medical procedures," says a statement from the American College of Obstetricians and Gynecologists.

The Catholic Health Association, representing the Catholic hospitals that care for about a sixth of U.S. patients, strongly supports the conscience ruling. The group says it's seen a number of efforts to force doctors to perform -- or make referrals -- for abortions and sterilizations.

"Ultimately, the central question is whether organizations and individuals should be required to participate in, pay for, provide coverage for, or refer for services that directly contradict their deeply held religious or moral beliefs and convictions," the Catholic Health Association noted in a Sept. 24 letter supporting the rule.

The Family Research Council, which strongly opposes abortion, also supports the ruling.

"This is a victory for the right of patients to choose doctors who decline to engage in morally objectionable practice," the FRC says in a statement.

A Sept. 24 letter signed by the AMA and many other medical groups says existing laws protect health care workers from having to participate in practices they find morally objectionable.

The rule, the letter says, "expands the range of health care institutions and individuals who may refuse to provide services, and broadens the scope ... beyond the actual provision of health care services to information and counseling about health services as well as referrals."

The letter suggests that the new protections are so broad, receptionists could refuse to schedule patients for medically necessary services, and people who "clean or maintain equipment or rooms" could interrupt patient care.

The incoming Obama administration could repeal the rule, but that would be a lengthy process. Congress could pass a law repealing the rule -- and such a bill has already been introduced by Senators Hillary Clinton, D-N.Y., and Patty Murray, D-Wash. Clinton and Murray led a group of 28 Senators that unsuccessfully urged Leavitt to halt the rule.